Meaningful Use Challenges – software or process?

Responses continue to roll in after the Dec 30, 2009 final rule proposal from The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).  As expected, there are some positive and some critical comments.  From reading them, one cannot help but wonder what percentage of the challenges raised are due to poorly designed EMR (or EHR) software and what percentage are due to clinical processes that resist change.  I suspect a good portion the problems are due to software.

EMR and EHR software have been in the market for many years, though many have not  delivered on their promises.  In fact, a friend in the business once said the product he sold probably bankrupted a number of medical practices due to problems with the billing and other modules.   Those who have purchased these software and experiencing problems are rightfully concerned that they not only have to spend money to swap out their current EMR, but they may also lose out on the EHR incentive money.

However, from an objective observer and healthcare consumer’s point of view, I believe the Meaningful Use goals are worthy and necessary.  What needs to happen is for the software vendors to respond to the complaints of the purchasing doctors as well as Meaningful Use requirements.  This press release by research firm KLAS points out some of the feature gaps that need to be plugged.

There is indeed a market opportunity for EHR and Health 2.0 tools delivered as SaaS as The Health Care Blog says.  They are more flexible, more integration friendly and less costly to implement (at least from an infrastructure perspective).  Those who have already implemented a clunky and inflexible system, ironically these are probably hospitals and financially endowed practices, can be seen expressing concerns such as “unreasonable threshholds for some meaningful use criteria, including computerized prescription order entry, electronic claim submission and electronic insurance eligibility verification”.

This will continue to be a space to watch, whether you are a technologist or a medical professional.  There is hope yet EHR will learn from consumer web innovations that millions have been using for a number of years.

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Why do doctors hate EMRs?

While trolling the web, I found this great article written by a physician about why doctors hate EMRs.  Electronic Medical Records, or its cousin EHR and even PHR, are supposed to help physicians provide better quality care to patients, ideally at lower costs to the society.  However, as you can see in this article, http://www.dillingerkovach.com/accusourcecareers/?p=10501, the adoption rate is abysmal.

As a software guy, and having studied cases of why Business Intelligence and other other enterprise software systems suffered poor adoption among their intended users, I can almost predict the usual barriers to adoption.  What makes the EMR case more interesting is that in small clinics, the physicians tend to be the buyers of the software too.  If they are unhappy with the product, they would simply not buy an EMR or abandon it after paying for it.   Those who are in larger enterprises (aka large clinics or hospitals), the unhappy docs will find anyway they can to get out of using it.

Why, you may ask, are these doctors so recalcitrant about technology?  The author said technology was not the problem.  According to him, docs use much more sophisticated technology everyday – MRI, cyro-probes, laser, etc.  Instead, it is because “It slows them down!”.   It isn’t the first time I hear this from a doc.  If you are in the business, I am sure you know this tune too.

Most EMRs, similar to ERP and other enterprise software, suffer from the same shortcomings.  Told poignantly by the author in this excerpt, the consumers suffer from a sign at a dry-cleaner’s shop reads: Low Prices, High Quality, Fast Service: Pick One. I am optimistic that we can get to a place where EMRs not only contribute to better care, lower costs and also user satisfaction (physicians’ and patients’).  It wouldn’t be trivial.  Some vendors won’t make it through.  If you have answers to the questions that the author raised in the article, I would love to see your comments.

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The slow revolution in Healthcare IT

For years, healthcare IT has been dominated by big players and arcane system architecture that resembled the ERP market in the 1990s.  Playing into this is the vendor dominated CCHIT certification process, which required everything under the sky to pass, but did little to ensure the software support a better care delivery or even integration with the disparate systems used by different physicians.  However, there are reasons to be optimistic as 2009 comes to a close, as written in this blog.

Looking at healthcare IT, I see a lot of parallels to how the enterprise IT space has evolved over the last 15 years.  There were many promises and much money spent, but little to show in the form of tangible quality improvements or cost savings.  Sure the marketplace will eventually sort out winners and losers, but I postulate that government stimulus money will make the outcome of this evolution different.

Granted, what needs to happen in this space isn’t limited to just moving the power from traditional HIT vendors.  The interoperability in HIT in general is abysmal.  Even new vendors aren’t much better at allowing physicians and patients share data.  However, there are reasons to be optimistic that people building HIT software would consider a multi-tenant system or a data sharing platform a fundamental requirement instead of an afterthought.

What do you think?  I am especially interested in hearing from those who are involved in healthcare delivery.  After all, I am peddling wares just like everybody else.  You the user should have the final say.

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